A rare case of multiple congenital epulis

Spontaneous regression of congenital epulis: a case report and review of the literature

Introduction

Congenital epulis is a rare lesion found on the alveolar process of a newborn child, diagnosed soon after birth. The lesion has a site predilection for the anterior maxillary alveolar process and a 9:1 sex predilection for females. Once diagnosed the traditional management of the lesion has been surgical excision under general anesthesia.

Case presentation

The purpose of this case report is to describe spontaneous regression of congenital epulis in a three week old healthy African American female child. She presented with a 1.5 cm bilobed sessile nodular lesion in the region of the right maxillary cuspid. The clinical impression was congenital epulis. Since the lesion was not interfering with feeding and respiration, a conservative approach was taken. The child was followed-up for 18 months, during which the lesion progressively regressed.

Conclusions

Conservative management prevented unnecessary surgery and anesthesia exposure in a neonate.

Congenital epulis in the newborn, review of the literature and a case report

Congenital epulis (CE) is a rare tumor of the newborn, also known as granular cell tumor or congenital gingival granular cell tumor because of its histologic features. Neumann first described CE in 1871. Epulis is seen only in the newborn and is a different entity from other granular cell tumors. CE has a female predilection with 8:1 ratio. Epulis is most frequently located on the anterior maxillary alveolar ridge and usually occurs as a single mass although 10% cases occur as multiple. CE clinically appears as a pedunculated protuberant mass, which may interfere with respiration or feeding. In cases with large lesions mechanical oral and nasal obstruction can impair fetal deglutition and neonatal respiratory efforts resulting in polyhydramnios prenatally or respiratory impairment postnatally. The exact histiogenesis is still uncertain. The recommended treatment is prompt surgical resection. Recurrences of the tumor and damage to future dentition have not been reported. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. We report a female neonate with congenital multiple tumors in the anterior maxillary alveolar ridge and review the relevant literature. The tumors were resected by surgical excision. The intraoperative and postoperative course was uneventful. Follow-up for 6 months did not show recurrence.

Congenital epulis of the jaw: a series of five cases and review of literature

This article describes five cases of congenital epulis, a rare and benign swelling in the mouth of a newborn, which is not widely known. We present five cases: four cases presented as single pedunculated nodules of the gingiva and in one case two nodules were present. Of all, 50% were located at the maxilla. Excision was performed in four of the five cases and in one case, spontaneous regression was awaited. No recurrence was reported. The characteristic features of congenital epulis are a pedunculated, flesh-pink coloured tumour with a predominant occurrence on the anterior maxillary alveolar ridge in a female newborn. Although the aetiology is unknown, most authors suggest a mesenchymal, rather than an odontogenic, origin. Endogenous hormonal factors might influence growth prenatally. Histological findings include granular cells with eosinophilic cytoplasm and small, eccentric nuclei. Despite the fact that the lesion can be a striking sight, spontaneous regression is possible and can be awaited. Indications for non-radical excision under local anaesthesia are severe upper airway obstruction and interference with feeding technique. In conclusion, we provide clinical and histological information about congenital epulis, so that this entity will be more easily recognised and relevant information given to parents.